title: A novel approach to cardiovascular health by optimizing risk management (ANCHOR): behavioural modification in primary care effectively reduces global risk.
abstract: BACKGROUND
  Primary care is well positioned to facilitate cardiovascular risk improvement and reduce future cardiovascular disease (CVD) burden.
  
  
  METHODS
  The efficacy of risk factor screening, behavioural counselling, and pharmacological treatment to lower CVD risk was assessed via a prospective pre- and postintervention health risk assessment, individualized intervention with behaviour modification, risk factor treatment, and linkage to community programs, with 1-year follow-up and final health risk assessment. Primary outcome was the proportion of subjects with moderate and high baseline Framingham Risk Score (FRS) reducing their risk by 10% and 25%, respectively; the secondary end point was the proportion dropping ≥ 1 risk category.
  
  
  RESULTS
  Patients were enrolled (N = 1509) from March 2006 through October 2008 and 72% completed the study. This analysis focuses on 563 subjects with moderate or high baseline FRS, and excluded 325 low-risk patients and 205 with established CVD or diabetes mellitus. Median age was 56 years, 57.7% were female. The primary outcome was achieved in 31.8% (N = 112; 95% confidence interval [CI], 26.9%-36.6%) of moderate risk FRS participants and 47.9% (N = 101; 95% CI, 41.2%-54.6%) of high-risk participants. The secondary outcome was achieved by 37.2% (N = 210; 95% CI, 33.2%-41.2%). Prevalence of metabolic syndrome fell from 79.2% (N = 446; 95% CI, 75.9%-82.6%) at entry to 52.8% (N = 303; 95% CI, 48.7%-56.9%) at study end. Significant improvements in all modifiable risk factors occurred through lifestyle modification.
  
  
  CONCLUSIONS
  Global cardiovascular risk can be effectively decreased via lifestyle changes informed by readiness to change assessment and individualized counselling targeting specific behaviours.
  
  
  BACKGROUND
  ClinicalTrials.gov number NCT01620996.
authors.affiliation: Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: jafna.cox@dal.ca.
authors.forename: Jafna L
authors.initials: JL
authors.lastname: Cox
authors.forename: T Michael
authors.initials: TM
authors.lastname: Vallis
authors.forename: Angela
authors.initials: A
authors.lastname: Pfammatter
authors.forename: Claudine
authors.initials: C
authors.lastname: Szpilfogel
authors.forename: Brendan
authors.initials: B
authors.lastname: Carr
authors.forename: Blair J
authors.initials: BJ
authors.lastname: O'Neill
mesh_terms: D002170:Canada; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003376:Counseling; D005260:Female; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D062405:Motivational Interviewing; D011320:Primary Health Care; D011322:Primary Prevention / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012308:Risk Management; D040242:Risk Reduction Behavior